MALES WITH EATING DISORDERS - CHALLENGES FOR TREATMENT AND RESEARCH

Males represent only 10 percent of eating disorder cases, This gender discrepancy is among the most extreme in psychiatry and medicine, Dete rmining which differences in etiology and mechanism best explain the d iscrepancy presents an intellectual challenge, Beginning at about the third grade, boys and girls diverge In social development, Boys show s ignificantly less desire to lose weight, express dissatisfaction with the upper rather than the lower body, and use dieting to achieve speci fic external goals rather than as a cultural norm. Mates reach a signi ficantly higher body mass index (BMI) than females do before they begi n dieting (27.2 versus 24.2, p<.01). While overall treatment principle s are similar, males in treatment require attainment of a different ho rmonal milieu (testosterone), attention to past and future sexual role , amelioration of perception of stigma, and preparation for return to mate social roles. Males and females suffer comparable degrees of oste openia and brain shrinkage during anorexia nervosa. The effectiveness of antidepressants in males with eating disorders (compared with that in females) has not been well studied. Male gender is not an adverse f actor in short-term or long-term treatment outcome. Understanding the lower frequency of these illnesses in males may lead to more effective means of protecting girls from eating disorders and from the cultural ly induced distress about normal body size and shape that burdens adol escent development and adult life.